Dehiscence and Fenestration Subsequent to Orthodontic Treatment in the Mandible

Objective: The purpose of this study was to systematically review the literature that reported orthodontic tooth movement that resulted in bony defects in the mandible. The two commonly known bony defects that may occur around periodontitis-free human dentition are dehiscence and fenestration. Methods: A search of PubMed, Medline, and all EBM reviews (Cochrane Database of Systematic Reviews, ASP Journal Club, DARE and CCTR) identified several articles that met the determined initial inclusion criteria. The original articles were then retrieved. A methodological checklist was used to evaluate the quality of the selected articles. References from the selected articles were also hand-searched for possible missing articles. Additional selection criteria were used to select the appropriate articles from their published abstracts. Results: The database search resulted in 27, 121 and 30 abstracts/titles in the three databases, respectively. After selecting the potential abstracts, reading the complete articles from the abstract selection and considering the final selection criteria only 11 articles were left. The methodological evaluation found several limitations in all studies. Conclusions: Orthodontic tooth movement of mandibular teeth against buccal and lingual alveolar plates may result in bone resorption and may cause bony defects that can be described as dehiscence and fenestration. Currently, the diagnosis of such defects is greatly limited by the lack of the accurate diagnostic tool. Most of the studies we reviewed relied on conventional two-dimensional radiography. With the advent of the three-dimensional tomography and Cone Beam CT Scan, more accurate interpretation of such consequences seems to be more diagnostically and clinically meaningful.